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Advisor(s)
Abstract(s)
Introdução: A procalcitonina é um marcador biológico para diagnóstico, monitorização da terapêutica e prognóstico de processos inflamatórios de etiologia infecciosa. Este estudo procura conhecer a realidade local face à sua requisição no Centro Hospitalar Cova da Beira.
Métodos: Realizou-se um estudo transversal retrospectivo. Foram seleccionadas todas as medições da procalcitonina sérica efectuadas nos serviços de Urgência e Unidade de Cuidados Intensivos do Centro Hospitalar Cova da Beira entre 1 de Janeiro de 2008 e 31 de Dezembro de 2009 e analisados estatisticamente os dados relativos aos pacientes aos quais correspondem essas medições.
Resultados: Na Urgência realizaram-se 121 medições da procalcitonina a 113 pacientes (1,07 medições por episódio) sendo o valor inicial, em média, de 6,55 ng/mL. Foi atribuída a cor amarela à maioria dos pacientes segundo a triagem de Manchester. Após o episódio de Urgência, 61,1% dos pacientes foram internados e 2,7% faleceram. Encontraram-se correlações estatísticas entre o valor inicial da procalcitonina e o valor inicial da proteína C-reactiva (p<0,001) e o desfecho do episódio de urgência (p<0,001). Aos 199 pacientes que estiveram na Unidade de Cuidados Intensivos durante o internamento foram realizadas 571 medições. A maioria dos pacientes esteve internado em dois serviços (72,9%), durante cerca de de 29,57 dias e estando, em média, 11,82 dias na Unidade de Cuidados Intensivos. O valor inicial da procalcitonina era, em média, de 13,71 ng/mL. Foram diagnosticados 78,9% e 33,2% dos pacientes com infecção e sépsis respectivamente. Dos infectados 62,42% tiveram culturas positivas, identificando bactérias em 94,90% dos casos. De todos os pacientes, 181 foram medicados com 3,24 antibióticos, medindo-se a procalcitonina em 70,17% , antes da antibioterapia ser instituída, sendo o valor inicial de 18,84 ng/mL. A proteína C-reactiva foi medida em 98,0% das vezes, com uma média da primeira medição de 32,06 mg/dL. A maioria dos pacientes morreu entre o final da primeira semana e o primeiro mês. A procalcitonina associa-se com a presença de infecção (p<0,001) e o diagnóstico de sépsis (p<0,001), sendo sobreponível aos valores da proteína C-reactiva (p=0,002). Os valores mais altos associam-se com a mortalidade até às 48 horas e consequentemente com o desfecho do internamento (p=0,002).
Conclusão: A procalcitonina é um marcador biológico capaz de identificar a presença de infecção/sépsis, contribuindo para o diagnóstico, avaliação da progressão da doença e início da antibioterapia, sendo, também, um bom indicador do prognóstico e uma boa alternativa ao uso da proteína C- reactiva.
Introduction: Procalcitonin is a biomarker of inflammatory processes of infectious etiology, helping in the diagnosis, prognosis and therapy monitoring. This study wants to identify the reality of requisition of procalcitonin in Centro Hospitalar Cova da Beira. Methods: This study is a retrospective cross-sectional study. All measurements of procalcitonin in Emergency Department and Intensive Care of Centro Hospitalar Cova da Beira between January 1, 2008 and December 31, 2009 have been selected and statistically analyzed. Results: In the Emergency Department were done 121 measurements of procalcitonin in 113 patients (1,07 measurements per episode). The initial value was 6,55 ng/mL, , on average. According to the Screening of Manchester, most patients were assigned with the yellow color. At the end of the episode, 61,1% patients were hospitalized and 2,7% died. Were found statistical correlations between the initial values of procalcitonin and C-reactive protein (p<0,001) and with the outcome of the episode of urgency (p<0,001). In the Intensive Care were done 571 measurements in 199 patients during hospitalization. Most patients were admitted in two departments (72,9%) for about 29,57 days, staying in the Intensive Care Unit for 11,82 days. On average the initial value of procalcitonin was 13,71 ng/mL. 78,9% and 33,2% have infection and sepsis respectively. 62,42% of those had positive cultures, identifying bacteria in 94,90%. From all the patients, 181 were treated, on average, with 3,24 antibiotics, measuring procalcitonin in 70.17%, before it is instituted and with an initial value of 18.84 ng/mL. C-reactive protein was measured in 98.0% of cases, with a value of 32.06 mg / dL, on average. Most patients died between the end of first week and first month. Procalcitonin was associated with presence of infection (p <0,001) and diagnosis of sepsis (p <0,001), and overlap with the values of C-reactive protein (p = 0.002). The highest values are associated with mortality up to 48 hours and consequently with the outcome of hospitalization (p = 0.002). Conclusion: Procalcitonin is a biomarker that can identify infection and sepsis, contributing to diagnosis, assessment of disease progression and initiation of antibiotic therapy, being a good indicator of prognosis and a good alternative to the use of protein C-reactive.
Introduction: Procalcitonin is a biomarker of inflammatory processes of infectious etiology, helping in the diagnosis, prognosis and therapy monitoring. This study wants to identify the reality of requisition of procalcitonin in Centro Hospitalar Cova da Beira. Methods: This study is a retrospective cross-sectional study. All measurements of procalcitonin in Emergency Department and Intensive Care of Centro Hospitalar Cova da Beira between January 1, 2008 and December 31, 2009 have been selected and statistically analyzed. Results: In the Emergency Department were done 121 measurements of procalcitonin in 113 patients (1,07 measurements per episode). The initial value was 6,55 ng/mL, , on average. According to the Screening of Manchester, most patients were assigned with the yellow color. At the end of the episode, 61,1% patients were hospitalized and 2,7% died. Were found statistical correlations between the initial values of procalcitonin and C-reactive protein (p<0,001) and with the outcome of the episode of urgency (p<0,001). In the Intensive Care were done 571 measurements in 199 patients during hospitalization. Most patients were admitted in two departments (72,9%) for about 29,57 days, staying in the Intensive Care Unit for 11,82 days. On average the initial value of procalcitonin was 13,71 ng/mL. 78,9% and 33,2% have infection and sepsis respectively. 62,42% of those had positive cultures, identifying bacteria in 94,90%. From all the patients, 181 were treated, on average, with 3,24 antibiotics, measuring procalcitonin in 70.17%, before it is instituted and with an initial value of 18.84 ng/mL. C-reactive protein was measured in 98.0% of cases, with a value of 32.06 mg / dL, on average. Most patients died between the end of first week and first month. Procalcitonin was associated with presence of infection (p <0,001) and diagnosis of sepsis (p <0,001), and overlap with the values of C-reactive protein (p = 0.002). The highest values are associated with mortality up to 48 hours and consequently with the outcome of hospitalization (p = 0.002). Conclusion: Procalcitonin is a biomarker that can identify infection and sepsis, contributing to diagnosis, assessment of disease progression and initiation of antibiotic therapy, being a good indicator of prognosis and a good alternative to the use of protein C-reactive.
Description
Keywords
Procalcitonina - Marcador biológico - Infecção (sépsis) Procalcitonina - Marcador biológico Procalcitonina - Diagnóstico Procalcitonina - Prognóstico Procalcitonina - Antibioterapia
Pedagogical Context
Citation
Publisher
Universidade da Beira Interior